Teaching German

Mental health

Migrant mental health concerns bubble under at World Health Summit

It will be the big item on the agenda at next year's World Health Summit. But, this year, only the most daring will mention mental health. And they are having to push for all it's worth.

You hear it a lot at the World Health Summit. Speaker after speaker tells you: "We need to focus less on the numbers and more on people." And it's true. Statistics can give you an idea of the size of a problem, but they don't necessarily let you understand the people, the patients, or the migrants and refugees who "desperately" need healthcare. Especially when it comes to mental health.

But you don't expect your focus to be so frequently directed at the person telling the story.

"When I went to Greece… When I went to Sierra Leone… I spoke to the children… and they asked me," started Helle Thorning-Schmidt, a former Danish prime minister and current CEO of Save The Children International. Clearly, it's her take on how to personalize the issue.

And what did the children ask? They asked why it was the Greek authorities kept them "locked up like criminals when we haven't done anything wrong."

No matter how you present the story, it is a fair question. Yet the anecdote fails to speak effectively to their situation. And it fails to adequately describe the situation for those of us living our comfortable western lives - other than to tell us that a certain prominent person spoke to a few "invisible" individuals.

Epidemic proportions

"There is a huge issue of mental health in Syria and Iraq. It's really huge," says Yves Daccord, the director general of the International Committee of the Red Cross (ICRC).

We know mental health is a serious issue in war and conflict zones, says Daccord. It is a problem "possibly of epidemic proportion."

He also says we need to "see the person" when we approach the issue of mental health. But still we lack sufficient information about individuals - migrants and refugees - suffering mental health issues, and we don't know how to manage their data.

"How do you track mental health at the recipient end [where migrants arrive] when you have no clue what the diagnosis was in the country of origin?" asks Daccord. "Is it linked to war? Is it linked to something to do with your family? What treatment did you receive? I have no clue."

Yves Daccord: Mental health in Syria and Iraq is possibly of epidemic proportions

Not knowing can have detrimental ramifications for ongoing care and pose a burden on healthcare services in the "recipient" countries. But that is just half the problem.

We see the images of migrants moving to Europe, and we quickly forget those who have stayed or were left behind.

"Development in reverse"

The refugees we see may make up about 3 percent of a population. Internally displaced people (IDPs), meanwhile, can be three times as many, and so-called "conflict affected residents" as many as 87 percent. These are the people left behind. They will live the effects of war even when peace is restored.

"Civil war is development in reverse," says Anke Hoeffler, an economist and researcher at Oxford University.

Hoeffler says an average civil war lasts eight years, but it can take a further 14 years for the country to get back on its feet. That includes its hospitals and healthcare professionals. How do you then treat a "silent" sickness like mental health?

Invisible sickness

Seeema Biswas, a war surgeon and editor-in-chief of BMJ Case Reports, says "indirect deaths in war outnumber direct deaths by multiple times."

Seema Biswas once operated on a patient in a war zone while the ceiling fell their heads

That includes patients suffering from measles, or diabetes because they can't access insulin, and even polio, which has reemerged in Syria despite having technically been eradicated.

But this also includes mental health, which, let's not forget, can be fatal.

Among a list of physical problems observed by Médecins Sans Frontières, MSF's head in Germany, Florian Westphal, cited visible traumas like fuel burns and skin diseases. On the sidelines, he also cited psychological issues. So the issue of mental health is visible at the World Health Summit in Berlin.

And it's clear from the discussions here that those on the frontline are aware that migrants and refugees are suffering from such issues. But you get the feeling it is only just becoming the next item on the agenda, and only the very few are trying to push the message through. In that sense mental health among migrants and refugees is no different from mental health among "normal" populations. Which can only mean: we have a long way to go.